What is it?

Bacterial vaginosis is an imbalance of the usual bacteria found in a woman’s vagina. It causes an abnormal vaginal discharge, which can smell fishy and unpleasant. Bacterial vaginosis can appear and disappear without any reason, and around half of all women with bacterial vaginosis are asymptomatic (do not have any symptoms). If there are no symptoms, treatment is not necessary. Where there are symptoms, antibiotics may be recommended.

The vagina

The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs). Some types of bacteria are always present in the vagina to keep it healthy. If a woman has bacterial vaginosis, the usual balance of bacteria changes. The vagina will have:

• less lactobacilli (lactic acid bacteria)
• an overgrowth of other types of bacteria
• a higher pH (the measure of acidity and alkalinity), making it more alkaline.

How common is bacterial vaginosis

Bacterial vaginosis is the most common cause of abnormal vaginal discharge. Around 12-30% of women may be affected. Among pregnant women, this figure may be around 20%. The cause of bacterial vaginosis is not fully understood, although some factors make it more likely. While bacterial vaginosis is not a sexually transmitted infection (STI), it is more common among people who are sexually active. Other factors that contribute to bacterial vaginosis include smoking and using certain hygiene products.

Symptoms of Bacterial Vaginosis

Around half of all women with bacterial vaginosis are asymptomatic. This means that they do not have any signs or symptoms. If you do not have symptoms, there is no need to get tested to find out if you have bacterial vaginosis. If you do have symptoms, you might notice a change in your usual vaginal discharge. Your discharge may:

• become thin and watery
• change to a white or grey colour, or develop a strong, unpleasant, fishy smell particularly after sexual intercourse.

Bacterial vaginosis does not usually cause itching or irritation.

Causes of Bacterial Vaginosis

Bacterial vaginosis occurs when there is a change in the natural bacterial balance in your vagina. Your vagina should contain lactobacilli (lactic acid bacteria). The lactobacilli produce lactic acid. This makes the vagina slightly acidic, which prevents other bacteria from growing there. However, if you have bacterial vaginosis, you have less lactobacilli, which means that your vagina is not as acidic as it should be. This allows other types of bacteria to grow. It is not fully understood what causes the levels of bacteria to change, although some factors have been identified that may contribute to bacterial vaginosis.

Contributing factors

Bacterial vaginosis is not a sexually transmitted infection (STI) because it is not passed to other people through intimate sexual contact. However, bacterial vaginosis is more common among people who are sexually active, including women in same-sex relationships. It is also more common among black women.

Other factors that may increase your risk of getting bacterial vaginosis include:

• having a new sexual partner
• having multiple sexual partners
• using an intrauterine device (IUD), a contraceptive device made from plastic and copper that fits inside the womb (uterus)
• smoking
• using scented soaps or perfumed bubble bath
• putting antiseptic liquids in the bath
• douching (washing or cleaning out the vagina with water or other fluids)
• using vaginal deodorant
• using strong detergents to wash your underwear

Diagnosing Bacterial Vaginosis

See your doctor as soon as possible if you have any abnormal discharge from your vagina. It is important to get bacterial vaginosis diagnosed to rule out other infections, such as trichomonas vaginalis or gonorrhea. These can both cause abnormal vaginal discharge.

If you prefer, you could visit a sexual health clinic for a diagnosis, instead of your doctor. Sexual health clinics are sometimes known as genito-urinary medicine (GUM) clinics. They are usually located in a hospital or are part of another health centre.

Examination and tests

Your doctor or healthcare professional may diagnose from a description of your symptoms and by examining your vagina. In particular, they will look for a thin, greyish discharge, and an unpleasant smell

In some cases, this may be enough to confirm your diagnosis. However, if you are sexually active and it is possible that you may have a sexually transmitted infection (STI) instead of bacterial vaginosis, you may need to have some further tests.

Your doctor or healthcare professional will use a swab or a small plastic loop to collect a sample of cells from the walls of your vagina. A swab looks a bit like a cotton bud but is smaller, soft and rounded. The swab or loop is used to pick up samples of discharge and cells. It only takes a few seconds and is not usually painful, although it may be slightly uncomfortable for a moment.

The samples will be examined to check for bacterial vaginosis. The result may be available immediately or the sample may be sent to a laboratory, in which case the result will usually be available within a week.

The pH (alkaline/acid balance) of your vagina may be measured. A swab will be taken from inside your vagina and wiped over a piece of specially treated paper. The paper changes colour depending on the pH level. A pH level higher than 4.5 is an indication that you may have bacterial vaginosis.

Related Articles:

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2.  Cir­cum­cision helps stop wart virus
3. The infections you can catch through oral sex
4. Symptoms and causes of chlamydia infection
5. Genital herpes during pregnancy
6. Lessons on genital human papilloma virus (HPV) infection

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